Treating Sprains and Strains

Sooner or later, every one of us ends up “pulling” something in our body. It usually happens so fast that it is over before you realize that you’ve injured yourself. You’ve probably heard the two terms sprain and strain and wondered if it is sort of like tah-may-toe or tah-mah-toe. As it turns out, they are two different types of injury. When you do something that causes a tear to muscle tissue it is called a “strain” (commonly known as a pulled muscle). A sprain, on the other hand, is a tear to connective tissue such as ligament, tendon or fascia. The main difference here is that muscles have an ample blood supply, whereas connective tissue has no blood supply, so healing times are typically longer (depending upon the severity of the injury).

The first indication that you have injured yourself is the immediate sensation of pain in the area. Some people report a snapping sound. This is usually more serious because it often indicates a complete tear as opposed to a partial tear. This might involve surgical reattachment of the tissue. Let’s hope this is not your situation. The next thing that you are likely to notice is tenderness followed by swelling, heat and redness in the area. This is caused by the ensuing inflammatory process and by broken capillaries from the injury. Over the next few days leaked blood from broken capillaries typically leads to bruising. What is the suggested treatment? Well to begin with, if the injury is serious, seek medical treatment immediately. If your experience tells you that it is just a mild strain or sprain, then follow the following steps. As with any injury, the acute phase (the first 48 – 72 hours) is the most critical. The acronym for treatment during this phase is PRICE. The strategy is as follows:

Protect the affected part from further injury. If the injury is in any way substantial, this means immobilizing the injured area. Immobilization of the injury allows tender new tissue to form and get established, and it keeps the injury from becoming more serious. Avoid any movement or activity thing that causes more pain. This involves common sense and includes such things as not getting back in the game, whatever the “game” is. Other forms of protection might include splinting, wrapping or covering the affected area.

Rest is important after an injury. Locally it reduces blood flow to the injured area. At a systemic level, it allows the body to do its important job of healing.

Ice is always recommended for the first 48 hours or until the swelling subsides. What we are really talking about here is cold therapy (freezer gel packs work best). Cold reduces swelling in the injured area and it sends the message of C-O-L-D along nerve pathways to the brain. This message often shuts off the pain signals while the cold is being applied. When using cold therapy, don’t leave it on for more than 10-15 minutes at a time and use a layer of fabric between the cold and the injury to avoid skin damage. The best approach is to apply ice for 12 minutes, then remove the ice for the same amount of time, allowing the area to warm up again. This can be repeated as often as necessary for the first few days after an injury.

Compression typically involves wrapping the injured area. This supports and protects the area but is done primarily to reduce inflammation.

Elevation of the injured area will also reduce inflammation and keep blood from pooling in the injured area. This is especially important with injuries of the lower extremity

Once you have passed the acute phase of your injury, you can begin to ease back into activity. As healing begins to take place, begin gentle movements. Ease gently into this phase since the treatment approach here is pretty much the opposite of the earlier suggestions for the acute phase. In this phase you begin carefully stretching and strengthening the injured area. The post-injury rest period and the injury itself will have caused some muscle weakness. Strengthening exercises will return the area to its original muscle tone and will protect the injured structures, making them less likely to be re-injured. After an injury, you can also expect reduced range of motion. Gentle stretching at this time will break scar tissue adhesions that restrict the proper range of motion. To do this, stretch only into the edge of the pain. Do not stretch into or beyond the pain. This will only lead to re-injury.

Seeing your family doctor is prudent after any injury. Once your injury has been diagnosed, a massage therapist can guide you through the whole post-injury process. As regulated health professionals, we can also assess the extent of soft tissue damage, treat the injured area, and give you specific advice on home care of acute, sub-acute and chronic phases of the injury. Eventually you will be given specific stretches and strengthening exercises to allow you to return to full function as soon as possible. Prompt treatment of an injury, followed up with home care exercises will go a long way toward reducing your healing time, getting back your range of motion, and reducing the chance of future injury to the area.

Brian FultonBrian Fulton is a Registered Massage Therapist that has been practicing in St. Catharines, Ontario since 1999. He is also an author and an educator. He conducts workplace health and wellness seminars, and was the health columnist for Dalhousie Peer magazine for over ten years. His book, The Placebo Effect in Manual Therapy- Improving Clinical Outcomes, printed by Handspring Publications, is available through Amazon.